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Rule 14-46.001 F.A.C. Florida Department of Transportation Dec 14,2016 <br /> Page 3 of 3 UTILITY PERMIT <br /> PERMIT NO: 2018-H-798-268 <br /> CERTIFICATION <br /> 1,the undersigned UAO and/or Utility Builder,hereby CERTIFY that the utilities were constructed and inspected in compliance with the UAM all incorporated <br /> documents.and special instructions.Pursuant to UAM Section 2.1 1,all changes have been approved by the FDOT's Approving Engineer and incorporated <br /> into this permit along with all other material certifications,test results,bore logs,approved plans changes,as-built plans or other required documentation. <br /> I also CERTIFY that work began on MM/DD/YYYY and was completed on MM/DD/YYYY and that the area was left in as good or better condition than <br /> when the work began. <br /> Utility Agency/Owner Utility Builder(when applicable) <br /> Signature:N/A Date N/A Signature:N/A Date N/A <br /> Name(printed):N/A Name(printed):NIA <br /> Title:N/A Title:N/A <br /> FINAL INSPECTION OF WORK <br /> ❑ The work was inspected and found to be in non-compliance as noted below: <br /> None <br /> ❑ All issues of non-compliance listed above have been brought into compliance and/or FDOT has no outstanding issues that need to be addressed by the <br /> UAO and/or Utility Builder.However,this final inspection does not release the UAO and/or Utility Builder oftheir continuing responsibilities pursuant <br /> to Rule 14-46.001,the UAM,all incorporated documents,and special instructions. <br /> FDOT Inspector: N/A Date: N/A <br /> Name: N/A <br /> Title: N/A <br />